Nov 2, 2006 - Mail and telephone survey of primary care physicians in Australia,. Canada .... List of patients' medications, including Rx by other doctors.
THE COMMONWEALTH FUND
The Commonwealth Fund 2006 International Health Policy Survey of Primary Care Physicians in Seven Countries Cathy Schoen, Robin Osborn, Phuong Trang Huynh, and Michelle M. Doty November 2006
2006 International Health Policy Survey
•
Mail and telephone survey of primary care physicians in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.
•
Final samples: 1003 Australia, 578 Canada, 1,006 Germany, 931 the Netherlands, 503 New Zealand, 1,063 United Kingdom, and 1,004 United States.
•
Conducted by Harris Interactive and subcontractors, and in the Netherlands by The Center for Quality of Care Research (WOK), Radboud University Nijmegen, from February 2006 to July 2006.
•
Cofunding from The Australian Primary Health Care Research Institute, The German Institute for Quality and Efficiency in Health Care, and The Health Foundation.
•
Core Topics: information technology and clinical record systems, access, care coordination, chronic care/use of teams, quality initiatives, and financial incentives.
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Primary Care Practices: Use of Information Technology and Clinical Information Systems
THE COMMONWEALTH FUND
Figure 1. Primary Care Doctors’ Use of Electronic Patient Medical Records, 2006 Percent
98
100
92
89
79 75
42
50
28
23
25
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 2. Electronic Medical Record System Access
Percent with capability to:
AUS
CAN
GER
NETH
NZ
UK
US
Share records electronically with clinicians outside your practice
10
6
9
45
17
15
12
Access records from outside the office
19
11
16
32
36
22
22
Provide patients with easy access to their records
36
6
15
8
32
50
10
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 3. Practice Use of Electronic Technology
Percent reporting routine use of:
AUS
CAN
GER
NETH
NZ
UK
US
Electronic ordering of tests
65
8
27
5
62
20
22
Electronic prescribing of medication
81
11
59
85
78
55
20
Electronic access to patients’ test results
76
27
34
78
90
84
48
Electronic access to patients’ hospital records
12
15
7
11
44
19
40
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 4. Doctor Routinely Receives Alert About Potential Problem with Drug Dose/Interaction Yes, using a manual system
Percent
Yes, using a computerized system
100
2
10
6
6
75
33
50
93
80 31
25
87
91
40
23
10
0
AUS
CAN
GER
28
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 5. Doctor Routinely Receives Alert to Provide Patients with Test Results Percent
Yes, using a manual system Yes, using a computerized system
100
75
17 50
25
8
30 52
37
32
6
0
AUS
CAN
GER
14
51
9
53
16 NETH
40
15 NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 6. Patients Routinely Sent Reminder Notices for Preventive or Follow-Up Care Yes, using a manual system Yes, using a computerized system
Percent
100
75
5 18
16
50 25
14
24
65 20
93
83
61
28
18
8
0
AUS
CAN
GER
32
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 7. Capacity to Generate Patient Information Percent of primary care practices reporting easy to generate List of patients by diagnosis List of patients' medications, including Rx by other doctors 100
75
92 68
81
74
80 55
63 59
88
72
50
37 37 26 25
25
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 8. Primary Care Practices with Advanced Information Capacity Percent reporting seven or more out of 14 functions* 100
75
87
83
72 59
50
32 19
25
8
0
AUS
CAN
GER
NETH
NZ
UK
* Count of 14: EMR, EMR access other doctors, outside office, patient; routine use electronic ordering tests, prescriptions, access test results, access hospital records; computer for reminders, Rx alerts, prompt tests results; easy to list diagnosis, medications, patients due for care. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
US
THE COMMONWEALTH FUND
Access Experiences and Office Hours
THE COMMONWEALTH FUND
Figure 9. Doctor’s Practice Has Arrangement for Patients’ After-Hours Care to See Nurse/Doctor Percent
95
100
81
90
87
76
75
47
50
40
25
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 10. Physicians’ Perception of Patient Access Patients Often Have Difficulty Paying for Medications
Patients Often Experience Long Waits for Diagnostic Tests
Percent
Percent
75
75
57 51
51 50
50
24
25
27
23
26
28
25
15
13 7
0
9
8
6 0
AUS
CAN
GER
NETH
NZ
UK
US
AUS
CAN
GER
NETH
NZ
UK
US
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Coordination of Care
THE COMMONWEALTH FUND
Figure 11. Doctors’ Reports of Care Coordination Problems
Percent saying their patients “often/sometimes” experienced:
AUS
CAN
GER
NETH
NZ
UK
US
Records or clinical information not available at time of appointment
28
42
11
16
28
36
40
Tests/procedures repeated because findings unavailable
10
20
5
7
14
27
16
Problems because care was not well coordinated across sites/providers
39
46
22
47
49
65
37
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 12. Receive Information Back After Referrals of Patients to Other Doctors/Specialists Percent reporting receive for “almost all” referrals (80% or more)
100
82
76 75
62
68
75
61
50
37
25
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 13. Length of Time to Receive a Full Hospital Discharge Report Percent saying 15 days or more or rarely receive a full report 100
75
58
53
50
52
48
28
23
17
25
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Care for Chronically Ill Patients and Use of Teams
THE COMMONWEALTH FUND
Figure 14. Percent of Doctors Reporting Practice Is Well Prepared to Care for Chronic Diseases
Percent reporting “well prepared”:
AUS
CAN
GER
NETH
NZ
UK
US
Patients with multiple chronic diseases
69
55
93
75
67
76
68
Patients with mental health problems
50
40
70
65
48
55
37
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 15. Capacity to Generate List of Patients by Diagnosis Percent reporting very difficult or cannot generate 75
50
43 33
25
14
10
7
6
NETH
NZ
1
0
AUS
CAN
GER
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 16. Doctor Routinely Gives Patients with Chronic Diseases Plan to Manage Care at Home Percent giving written plan 100
75
63
50
29 25
25 14
33 18
21
0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 17. Use of Multidisciplinary Teams and Non-Physicians
AUS
CAN
GER
NETH
NZ
UK
US
30
81
29
Practice routinely uses multidisciplinary teams: Yes
32
32
49
50
Practice routinely uses clinicians other than doctors to: Help manage patients with multiple chronic diseases
38
25
62
46
57
73
36
Provide primary care services
38
22
56
33
51
70
39
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Quality Initiatives
THE COMMONWEALTH FUND
Figure 18. Physician Participation in Activities to Improve Quality of Care
AUS
CAN
GER
NETH
NZ
UK
US
Percent in past two years who: Participated in collaborative QI efforts
58
48
76
70
78
58
49
Conducted clinical audit of patient care
76
45
69
46
82
96
70
27
70
35
41
70
50
Percent reporting their practice: Sets formal targets for clinical performance
26
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 19. Availability of Data on Clinical Outcomes or Performance
Percent reporting yes:
AUS
CAN
GER
NETH
NZ
UK
US
Patients’ clinical outcomes
36
24
71
37
54
78
43
Surveys of patient satisfaction and experiences
29
11
27
16
33
89
48
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 20. Practice Had Documented Process for Follow-Up/Analysis of Adverse Events
AUS
CAN
GER
NETH
NZ
UK
US
Yes, for all adverse events
35
20
32
7
41
79
37
Yes, for adverse drug reactions only
21
19
26
10
19
8
19
Do not have a process
44
58
42
82
40
13
41
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 21. Primary Care Doctors’ Reports of Financial Incentives Targeted on Quality of Care
Percent receive financial incentive:*
AUS
CAN
GER
NETH
NZ
UK
US
Achieving certain clinical care targets
33
10
9
6
43
92
23
High ratings for patient satisfaction
5
—
5
1
2
52
20
Managing patients with chronic disease/ complex needs
62
37
24
47
68
79
8
Enhanced preventive care activities
53
13
28
18
42
72
12
Participating in quality improvement activities
35
7
21
28
47
82
19
* Receive or have the potential to receive. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
THE COMMONWEALTH FUND
Figure 22. Primary Care Doctors’ Reports of Any Financial Incentives Targeted on Quality of Care Percent reporting any financial incentive*
95
100
75
79
72 58
50
41
43 30
25
0
AUS
CAN
GER
NETH
NZ
UK
* Receive of have potential to receive payment for: clinical care targets, high patient ratings, managing chronic disease/complex needs, preventive care, or QI activities. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
US
THE COMMONWEALTH FUND
Health System Views and Practice Satisfaction
Figure 23. Physician Views of the Health System
Percent saying:
AUS
CAN
GER
NETH
NZ
UK
US
Only minor changes needed
38
23
4
52
34
23
13
Fundamental changes needed
56
71
54
42
62
68
69
5
3
42
3
4
9
16
Rebuild completely
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 24. Dissatisfaction with Medical Practice
Percent very or somewhat dissatisfied with:
AUS
CAN
GER
NETH
NZ
UK
US
Freedom to make clinical decisions
8
12
74
10
26
24
31
Time to spend per patient
33
36
50
35
33
51
42
Income from medical practice
36
40
53
23
44
18
47
Overall experience with medical practice
14
16
19
9
23
14
23
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 25. Ability to Provide Quality Medical Care Compared with Five Years Ago Percent
Improved
100
Become worse
83 75
50
25
45
39
36 17
26
22
48
40
37 25
27
21
5 0
AUS
CAN
GER
NETH
NZ
UK
US THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 26. Primary Care: Summary and Implications
•
Striking differences across the countries in elements of primary care practice systems that underpin quality and efficiency.
•
Physicians in Australia, the Netherlands, New Zealand and the U.K. most likely to report multitask IT systems; U.S. and Canada lag behind.
•
Reports indicate varying capacity to care for patients with multiple chronic conditions or coordinate care with decision support.
•
Integration and coordination are a shared challenge.
•
Widespread primary care doctor participation in a range of quality improvement activities although safety tracking systems are rare except in the U.K.
•
U.S. stands out for financial barriers and also has limited after-hours access.
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Figure 27. Opportunities to Learn to Inform Policy
•
Country patterns reflect underlying strategic policy choices and extent to which policies are national in scope: – Payment policies for quality and care management. – IT: Investing in primary care capacity and interconnectedness. – After-hours access. – Chronic disease management and use of teams.
•
Primary care “redesign” is central to initiatives to improve health care system performance internationally.
•
Evidence that national “system” focus is essential to build capacity.
•
Striking country differences in primary care practices and national initiatives offer rich opportunities to learn.
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Acknowledgments
With appreciation to: •
Coauthors: Phuong Trang Huynh, Michelle M. Doty, Jordon Peugh, and Kinga Zapert, “On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries,” Health Affairs Web Exclusive (Nov. 2, 2006):w555–w571.
•
Developing and Conducting Survey: Harris Interactive and Associates.
•
Conducting Survey in the Netherlands: The Center for Quality of Care Research (WOK), Radboud University Nijmegen.
•
Cofunders: The Australian Primary Health Care Research Institute, The German Institute for Quality and Efficiency in Health Care, and The Health Foundation.
THE COMMONWEALTH FUND
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
